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Physical Therapy for the Critically Ill in the ICU: A Systematic Review and Meta-Analysis*

Kayambu, Geetha BSc Phyt (Hons)1; Boots, Robert PhD1,2; Paratz, Jennifer PhD1

doi: 10.1097/CCM.0b013e31827ca637
Review Articles

Objective: The purpose of this systematic review was to review the evidence base for exercise in critically ill patients.

Data Sources and Study Selection: Using keywords critical care and physical therapy and related synonyms, randomized controlled trials, meta-analyses, and systematic reviews were identified through electronic database searches and citation tracking. Clinical trials with outcomes of mortality, length of hospital and ICU stay, physical function and quality of life, muscle strength, and ventilator-free days were included.

Data Extraction and Synthesis: Two reviewers abstracted data and assessed quality independently. Effect sizes and 95% confidence intervals were calculated. From 3,126 screened abstracts, 10 randomized controlled trials and five reviews were found. The mean Physiotherapy Evidence Database score was 5.4. Overall there was a significant positive effect favoring physical therapy for the critically ill to improve the quality of life (g = 0.40, 95% confidence interval 0.08, 0.71), physical function (g = 0.46, 95% confidence interval 0.13, 0.78), peripheral muscle strength (g = 0.27, 95% confidence interval 0.02, 0.52), and respiratory muscle strength (g = 0.51, 95% confidence interval 0.12, 0.89). Length of hospital (g = –0.34, 95% confidence interval –0.53, –0.15) and ICU stay (g = –0.34, 95% confidence interval –0.51, –0.18) significantly decreased and ventilator-free days increased (g = 0.38, 95% confidence interval 0.16, 0.59) following physical therapy in the ICU. There was no effect on mortality.

Conclusion: Physical therapy in the ICU appears to confer significant benefit in improving quality of life, physical function, peripheral and respiratory muscle strength, increasing ventilator-free days, and decreasing hospital and ICU stay. However, further controlled trials of better quality and larger sample sizes are required to verify the strength of these tentative associations.

1 Burns, Trauma and Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.

2 Department of Intensive Care Medicine, The Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia.

*See also p. 1589.

All authors contributed to the systematic review. Ms. Kayambu and Dr. Paratz contributed to the article selection and assessment process. Ms. Kayambu performed the meta-analysis and developed the forest plots and drafted the manuscript. All authors critically revised the manuscript for important intellectual content. All authors approved the final version of the manuscript for publication.

Ms. Kayambu is supported, in part, by a Postgraduate Award from Singapore. Dr. Paratz is a Research Fellow of the Burns, Trauma and Critical Care Research Centre and Dr. Boots is Deputy Director of Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital.

The authors have not disclosed any potential conflicts of interest.

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© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins